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      El rol del cirujano plástico en las mordeduras por ofidios en niños: presentación de 2 casos Translated title: The role of the plastic surgeon in snake bites in children: two cases report

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          Abstract

          Resumen Las mordeduras de ofidios venenosos son lesiones potencialmente letales y continúan siendo un problema de salud en muchos países. Pueden determinar secuelas locorregionales y son más graves en los niños. Si bien existe consenso en cuanto al tratamiento sistémico, los datos acerca del tratamiento local son escasos y controversiales. Con frecuencia se convoca al cirujano plástico pediátrico para participar en el tratamiento de las heridas, el cual difiere del que solemos realizar en lesiones de otra etiología. Presentamos dos casos clínicos en los que obtuvimos excelentes resultados con el tratamiento conservador guiados por las recomendaciones del equipo de Toxicología y realizamos una revisión bibliográfica del tema.

          Translated abstract

          Abstract Snake envenomation are potentially deadly accidents that still represent a public health issue in some countries. They may determine severe locoregional sequalae and are more serious in children. General treatment has been agreed, but there is little information available about adequate local management, where controversy remains. The pediatric plastic surgeon is usually involved in local treatment, which differs from standard measures applied to wound care in other situations. We present two clinical cases which, following the recommendations from toxicologists, received conservative treatment with excellent results, and we conducted a bibliographical review on the subject.

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          Pediatric snakebites: lessons learned from 114 cases.

          Evidence-based guidelines for the treatment of pediatric snakebite injuries are lacking because they occur infrequently in most centers. We reviewed our experience treating snakebites from January 1995 through December 2005. Demographic (eg, age, sex, geographic location) and clinical information (eg, location of bite, species of snake, vital signs, laboratories, treatment, hospital length of stay) were obtained. Over the last decade, we have treated 114 children with confirmed snakebites. Mean age was 7.3 +/- 4.2 years (range, 1-17 years), and snakebites were more common in males (n = 68, 60%). All bites occurred on the extremities, and lower extremity bites were more common (n = 71, 62%). Copperheads inflicted the most bite injuries (n = 65, 57%), followed by rattlesnakes (n = 9, 8%) and cottonmouths (n = 7, 6%). The snake was not identified in 33 (29%) cases. Seven (6%) children were treated with Crotalidae antivenin. Of the children treated with antivenin, only 4 met criteria for treatment, and 1 had an anaphylactic reaction. If compartment syndrome was suspected based on neurovascular examination, compartment pressures were measured. Only 2 (1.8%) patients required fasciotomies. Over the last 2 years, we have stopped empiric treatment with antibiotics and have not observed any infectious complications. Average hospital length of stay was 30 +/- 25 hours. Most children bitten by pit vipers can be managed conservatively with analgesics and elevation of the affected extremity. Treatment with Crotalidae antivenin, antibiotics, and fasciotomy is rarely indicated.
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            Factors affecting outcome in children with snake envenomation: a prospective observational study.

            To evaluate clinical outcome and factors affecting outcome in children with snake envenomation. Prospective observational study. Paediatric intensive care unit of a tertiary care teaching hospital in India. We prospectively enrolled children ≤12 years of age admitted to our hospital with a definitive history of snake bite from August 2007 to June 2010. Demographic characteristics and clinical course of the enrolled children were recorded in a structured proforma and analysed using appropriate statistical methods. Children were treated as per the WHO guidelines (2005) on the management of snake bite in children. Of 110 children studied, 77 (69%) were male. Most (72; 64.2%) had features predominantly of haematotoxic envenomation while 20 (18%) and 18 (16%) children had features of neurotoxic envenomation and local involvement, respectively. 14 children (13%) died and 13 (12%) had major disabilities. On univariable analysis, the following prehospital and admission variables were found to be significantly associated with poor outcome: age, walking for >1 km after the bite, vomiting, haemoglobin ≤10 g/dl at admission and species of snake (cobra). On multivariable analysis, only younger age (adjusted OR 0.85; 95% CI 0.7 to 0.9), walking for >1 km after the bite (adjusted OR 57; 95% CI 4.2 to 782) and haemoglobin ≤10 g/dl at admission (adjusted OR 6; 95% CI 2 to 18.2) remained significant. Younger age at presentation, anaemia (haemoglobin ≤10 g/dl) and distance walked after the bite may be independent predictors of mortality and morbidity in children with snake bite. These features in victims of snake bite warrant early referral to and management in tertiary care centres.
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              Snake Bite Management: A Scoping Review of the Literature

              Background: Around the world, snake bite envenomation remains an underreported human health hazard. Envenomation can cause local and systemic complications, especially when there is a lack of antivenom availability. Although there are established guidelines regarding snake bite management acute care, there is a paucity of data regarding surgical intervention and the plastic surgeon’s role treating this unique patient population. Methods: A review was conducted identifying relevant published articles involving snake bite management and treatment in PubMed and EMBASE. Results: One hundred ten articles were identified and 77 met inclusion criteria. Snake bite envenomation can result in complications that are dependent upon a variety of variables. The literature has shown the best field treatment to be timely transportation to the nearest medical facility, along with antivenom administration. The cytotoxic, hemotoxic, and neurotoxic effects of venom can cause a variety of local soft tissue and systemic complications. Surgical interventions such as fasciotomies, wound debridements, skin grafts, and tissue flaps may be necessary in these patients to optimize functional and aesthetic outcomes. Disparities in access to care in resource limited settings are discussed. Conclusions: Global health disparities and insufficient antivenom distribution create an inequality of care in snake bite patients. Plastic surgeons have an important role in managing acute and chronic complications of snake bite envenomations that can lead to improved patient outcomes.
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                Author and article information

                Journal
                cpil
                Cirugía Plástica Ibero-Latinoamericana
                Cir. plást. iberolatinoam.
                Sociedad Española de Cirugía Plástica, Reparadora y Estética (SECPRE) (Madrid, Madrid, Spain )
                0376-7892
                1989-2055
                December 2022
                : 48
                : 4
                : 465-472
                Affiliations
                [2] Montevideo orgnameCentro Hospitalario Pereira Rossell orgdiv1Unidad del Niño Quemado, Cirugía Reparadora y Malformaciones Uruguay
                [1] Montevideo orgnameCentro Hospitalario Pereira Rossell orgdiv1Unidad del Niño Quemado, Cirugía Reparadora y Malformaciones Uruguay
                Article
                S0376-78922022000400014 S0376-7892(22)04800400014
                10.4321/s0376-78922022000400014
                4d32c441-46d1-4dc7-a24b-ef94396465a5

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 05 July 2022
                : 30 November 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 11, Pages: 8
                Product

                SciELO Spain

                Categories
                Reconstructiva

                Pacientes pediátricos,Mordedura ofidios,Niños,Snake bites,Pediatric patients,Child

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